Ultrasound-mediated delivery of doxorubicin to the brain results in immune modulation and improved responses to PD-1 blockade in gliomas.

Given the marginal penetration of most drugs across the blood-brain barrier, the efficacy of various agents remains limited for glioblastoma (GBM). Here we employ low-intensity pulsed ultrasound (LIPU) and intravenously administered microbubbles (MB) to open the blood-brain barrier and increase the concentration of liposomal doxorubicin and PD-1 blocking antibodies (aPD-1). We report results on a cohort of 4 GBM patients and preclinical models treated with this approach. LIPU/MB increases the concentration of doxorubicin by 2-fold and 3.9-fold in the human and murine brains two days after sonication, respectively. Similarly, LIPU/MB-mediated blood-brain barrier disruption leads to a 6-fold and a 2-fold increase in aPD-1 concentrations in murine brains and peritumoral brain regions from GBM patients treated with pembrolizumab, respectively. Doxorubicin and aPD-1 delivered with LIPU/MB upregulate major histocompatibility complex (MHC) class I and II in tumor cells. Increased brain concentrations of doxorubicin achieved by LIPU/MB elicit IFN-γ and MHC class I expression in microglia and macrophages. Doxorubicin and aPD-1 delivered with LIPU/MB results in the long-term survival of most glioma-bearing mice, which rely on myeloid cells and lymphocytes for their efficacy. Overall, this translational study supports the utility of LIPU/MB to potentiate the antitumoral activities of doxorubicin and aPD-1 for GBM.

Repeated blood-brain barrier opening with an implantable ultrasound device for delivery of albumin-bound paclitaxel in patients with recurrent glioblastoma: a phase 1 trial.

BACKGROUND: Low-intensity pulsed ultrasound with concomitant administration of intravenous microbubbles (LIPU-MB) can be used to open the blood-brain barrier. We aimed to assess the safety and pharmacokinetics of LIPU-MB to enhance the delivery of albumin-bound paclitaxel to the peritumoural brain of patients with recurrent glioblastoma. METHODS: We conducted a dose-escalation phase 1 clinical trial in adults (aged ≥18 years) with recurrent glioblastoma, a tumour diameter of 70 mm or smaller, and a Karnofsky performance status of at least 70. A nine-emitter ultrasound device was implanted into a skull window after tumour resection. LIPU-MB with intravenous albumin-bound paclitaxel infusion was done every 3 weeks for up to six cycles. Six dose levels of albumin-bound paclitaxel (40 mg/m2, 80 mg/m2, 135 mg/m2, 175 mg/m2, 215 mg/m2, and 260 mg/m2) were evaluated. The primary endpoint was dose-limiting toxicity occurring during the first cycle of sonication and albumin-bound paclitaxel chemotherapy. Safety was assessed in all treated patients. Analyses were done in the per-protocol population. Blood-brain barrier opening was investigated by MRI before and after sonication. We also did pharmacokinetic analyses of LIPU-MB in a subgroup of patients from the current study and a subgroup of patients who received carboplatin as part of a similar trial (NCT03744026). This study is registered with ClinicalTrials.gov, NCT04528680, and a phase 2 trial is currently open for accrual. FINDINGS: 17 patients (nine men and eight women) were enrolled between Oct 29, 2020, and Feb 21, 2022. As of data cutoff on Sept 6, 2022, median follow-up was 11·89 months (IQR 11·12-12·78). One patient was treated per dose level of albumin-bound paclitaxel for levels 1 to 5 (40-215 mg/m2), and 12 patients were treated at dose level 6 (260 mg/m2). A total of 68 cycles of LIPU-MB-based blood-brain barrier opening were done (median 3 cycles per patient [range 2-6]). At a dose of 260 mg/m2, encephalopathy (grade 3) occurred in one (8%) of 12 patients during the first cycle (considered a dose-limiting toxicity), and in one other patient during the second cycle (grade 2). In both cases, the toxicity resolved and treatment continued at a lower dose of albumin-bound paclitaxel, with a dose of 175 mg/m2 in the case of the grade 3 encephalopathy, and to 215 mg/m2 in the case of the grade 2 encephalopathy. Grade 2 peripheral neuropathy was observed in one patient during the third cycle of 260 mg/m2 albumin-bound paclitaxel. No progressive neurological deficits attributed to LIPU-MB were observed. LIPU-MB-based blood-brain barrier opening was most commonly associated with immediate yet transient grade 1-2 headache (12 [71%] of 17 patients). The most common grade 3-4 treatment-emergent adverse events were neutropenia (eight [47%]), leukopenia (five [29%]), and hypertension (five [29%]). No treatment-related deaths occurred during the study. Imaging analysis showed blood-brain barrier opening in the brain regions targeted by LIPU-MB, which diminished over the first 1 h after sonication. Pharmacokinetic analyses showed that LIPU-MB led to increases in the mean brain parenchymal concentrations of albumin-bound paclitaxel (from 0·037 µM [95% CI 0·022-0·063] in non-sonicated brain to 0·139 µM [0·083-0·232] in sonicated brain [3·7-times increase], p<0·0001) and carboplatin (from 0·991 µM [0·562-1·747] in non-sonicated brain to 5·878 µM [3·462-9·980] µM in sonicated brain [5·9-times increase], p=0·0001). INTERPRETATION: LIPU-MB using a skull-implantable ultrasound device transiently opens the blood-brain barrier allowing for safe, repeated penetration of cytotoxic drugs into the brain. This study has prompted a subsequent phase 2 study combining LIPU-MB with albumin-bound paclitaxel plus carboplatin (NCT04528680), which is ongoing. FUNDING: National Institutes of Health and National Cancer Institute, Moceri Family Foundation, and the Panattoni family.

Comparison of different types of diffusive gradient in thin film samplers for measurement of dissolved methylmercury in freshwaters.

Determination of bioavailable concentrations of methylmercury (MeHg(+)) in freshwater is key to further understanding its potential risk and toxicity. In this work, two in-house-manufactured mercury-specific diffusive gradients in thin films (DGT) were used in laboratory to assess the lability of MeHg(+), and to develop a relationship between chemical lability and bioavailability. After diffusing through the diffusive gel, the MeHg(+) accumulated in a thiol functionalised resin gel was extracted using acidic thiourea that was analysed using aqueous-phase propylation followed by headspace solid-phase microextraction (HS-SPME) and gas chromatography (GC) coupled to pyrolysis-atomic fluorescence spectrometry (Py-AFS) detection. The diffusion coefficient (D) at 25°C in agarose (A-DGT) in the absence and presence of dissolved organic matter (DOM) was obtained. Moreover, these values were experimentally compared against polyacrylamide (P-DGT), which is the most frequently used DGT for mercury to date. Statistically significant differences were observed between D values for A-DGT in the absence (3.15×10(-6) cm(2) s(-1)) and presence of DOM (2.68×10(-6) cm(2) s(-1)) and also for P-DGT (2.49×10(-6) and 1.69×10(-6) cm(2) s(-1)). Interestingly, our results show that diffusion of MeHg(+) was higher on agarose diffusive gel with and without DOM in comparison with those observed in polyacrylamide. Even with higher diffusion coefficients of MeHg(+) in the agarose diffusion layer, however, DGT based on polyacrylamide seems to be a better choice for eutrophic waters, when monitoring very low concentrations of MeHg(+), considering its slightly higher uptake capacity.

Towards universal wavelength-specific photodegradation rate constants for methyl mercury in humic waters, exemplified by a Boreal lake-wetland gradient.

We report experimentally determined first-order rate constants of MeHg photolysis in three waters along a Boreal lake-wetland gradient covering a range of pH (3.8-6.6), concentrations of total organic carbon (TOC 17.5-81 mg L(-1)), total Fe (0.8-2.1 mg L(-1)), specific UV254 nm absorption (3.3-4.2 L mg(-1) m(-1)) and TOC/TON ratios (24-67 g g(-1)). Rate constants determined as a function of incident sunlight (measured as cumulative photon flux of photosynthetically active radiation, PAR) decreased in the order dystrophic lake > dystrophic lake/wetland > riparian wetland. After correction for light attenuation by dissolved natural organic matter (DOM), wavelength-specific (PAR: 400-700 nm, UVA: 320-400 nm and UVB: 280-320 nm) first-order photodegradation rate constants (kpd) determined at the three sites were indistinguishable, with average values (± SE) of 0.0023 ± 0.0002, 0.10 ± 0.024 and 7.2 ± 1.3 m(2) E(-1) for kpdPAR, kpdUVA, and kpdUVB, respectively. The relative ratio of kpdPAR, kpdUVA, and kpdUVB was 1:43:3100. Experiments conducted at varying MeHg/TOC ratios confirm previous suggestions that complex formation with organic thiol groups enhances the rate of MeHg photodegradation, as compared to when O and N functional groups are involved in the speciation of MeHg. We suggest that if the photon fluxes of PAR, UVA, and UVB radiation are separately determined and the wavelength-specific light attenuation is corrected for, the first-order rate constants kpdPAR, kpdUVA, and kpdUVB will be universal to waters in which DOM (possibly in concert with Fe) controls the formation of ROS, and the chemical speciation of MeHg is controlled by the complexation with DOM associated thiols.

Atmospheric influence on the distribution of organic pollutants in the Guadalquivir River estuary, SW Spain.

In the lower Guadalquivir river basin, a system stressed by a wide variety of anthropogenic activities, eight pesticides (four triazines, two chloroacetanilide herbicides, one organochlorine, and one organophosphorus insecticide); and four emerging pollutants (two personal care products, one organophosphorous flame retardant, and one xanthine alkaloid) were analyzed in river water during a 2-year monitoring program, and after rain episodes. Samples were extracted using the solid phase extraction (SPE) technique prior to determination of compounds using gas chromatograph coupled to a mass spectrometer detector. Except for caffeine, recoveries were mostly above 80 %, while limits of detection and quantification were in the low nanograms per liter level (except for dimethoate). Terbuthylazine, simazine (triazine herbicides), and dimethoate (organophosphorus insecticide), present in agrochemicals, were predominant in the river water, although concentrations were below the quality standards established by the EU Water-Framework-Directive. A general trend to increase concentration was observed after rain events, in particular for pesticides, possibly as a consequence of surface runoff.

New insights into mercury bioaccumulation in deep-sea organisms from the NW Mediterranean and their human health implications.

A number of studies have found high levels of mercury (Hg) in deep-sea organisms throughout the world's oceans, but the underlying causes are not clear as there is no consensus on the origin and cycling of Hg in the ocean. Recent findings suggested that Hg accumulation may increase with increasing forage depth and pointed to the deep-water column as the origin of most Hg in marine biota, especially its organic methylmercury (MeHg) form. In the present study, we determined the total mercury (THg) levels in 12 deep-sea fish species and a decapod crustacean and investigated their relationship with the species' nitrogen stable isotope ratio (δ(15)N) as an indicator of their trophic level, average weight and habitat depth. THg levels ranged from 0.27 to 4.42 µg/g w.w. and exceeded in all, except one species, the recommended 0.5 µg/g w.w. guideline value. While THg levels exhibited a strong relationship with δ(15)N values and to a lesser extent with weight, the habitat depth, characterized as the species' depth of maximum abundance (DMA), had also a significant effect on Hg accumulation. The fish species with a shallower depth range exhibited lower THg values than predicted by their trophic level (δ(15)N) and body mass, while measured THg values were higher than predicted in deeper-dwelling fish. Overall, the present results point out a potential risk for human health from the consumption of deep-sea fish. In particular, for both, the red shrimp Aristeus antennatus, which is one of the most valuable fishing resources of the Mediterranean, as well as the commercially exploited fish Mora moro, THg levels considerably exceeded the recommended 0.5µg/g w.w. limit and should be consumed with caution.